Abstract
Objective: Residual dizziness is a disorder of unknown pathophysiology, which may occur after repositioning procedures for benign paroxysmal positional vertigo. This study evaluates the relationship between regular daily physical activity and the development of residual dizziness after treatment for benign paroxysmal positional vertigo. Study Design: Prospective observational cohort study. Setting: Academic university hospital. Methods: Seventy-one patients admitted with benign paroxysmal positional vertigo involving the posterior semicircular canal were managed with Epley’s procedure. Three days after successful treatment, the patients underwent a telephone interview to investigate vertigo relapse. If the patients no longer complained of vertigo, they were asked about symptoms consistent with residual dizziness. Subsequently, they were asked about the recovery of physical activities they regularly performed prior to the onset of vertigo. Results: Sixty-nine patients (age: 57.79 ± 15.05) were enrolled: five (7.24%) reported vertigo relapse whereas twenty-one of sixty-four non-relapsed patients (32.81%) reported residual dizziness. A significant difference in the incidence of residual dizziness was observed considering the patients’ age (p = 0.0003). Of the non-relapsed patients, 46 (71.88%) recovered their regular dynamic daily activities after treatment and 9 (19.57%) reported residual dizziness, while 12 of the 18 patients (66.67%) who did not resume daily activity reported residual symptoms (p = 0.0003). A logistic regression analysis showed a significant association between daily activity resumption and lack of residual dizziness (OR: 14.01, 95% CI limits 3.14–62.47; p = 0.001). Conclusions: Regardless of age, the resumption of regular daily physical activities is associated with a lack of residual dizziness.
Highlights
Benign paroxysmal positional vertigo (BPPV) is the most common vestibular complaint, consisting of short-lasting vertigo spells triggered by head position changes
In total 39 patients (56.52%) required a single canalith repositioning procedure (CRP) to recover from Posterior Semicircular Canal (PSC)-BPPV, 14 (20.28%) received two CRPs, 11 (15.94%) required three CRPs, while 5 subjects received up to 6 CRPs (7.24%)
Some authors assume that residual symptoms could represent a subclinical variant otoconial matter, they argue, results in mild dizziness, it does not provoke of BPPV due to the persistence of debris in the semicircular canal lumen
Summary
In this prospective observational trial, we enrolled 76 patients (30 male and 46 female) admitted to the emergency room for vertigo who were diagnosed with PSC-BPPV.Patients affected by other BPPV forms, multiple semicircular canals involvement or with a history consistent with previous vestibular disorders other than BPPV were excluded, as were patients who missed the scheduled follow-up visits. In this prospective observational trial, we enrolled 76 patients (30 male and 46 female) admitted to the emergency room for vertigo who were diagnosed with PSC-BPPV. All the patients received a bedside neurotological evaluation, including an examination of ocular alignment, saccades, smooth pursuit, and gait. Both spontaneous and gazeevoked nystagmus with and without fixation were checked using infrared video-Frenzel goggles. According to our nystagmus-based approach, the patients underwent diagnostic positioning tests for BPPV according to the minimum stimulus strategy [25,26]. PSC-BPPV was diagnosed if the Dix–Hallpike test evoked typical paroxysmal nystagmus (up-beating and torsional nystagmus with the upper pole of the eyes beating toward the undermost ear, lasting < 1 min)
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